A1 and A2, Sagittal (A1) and axial (A2) T2-weighted MR images from a patient with SS show a cervicothoracic epidural fluid-filled collection (white arrows)

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A1 and A2, Sagittal (A1) and axial (A2) T2-weighted MR images from a patient with SS show a cervicothoracic epidural fluid-filled collection (white arrows) and a T5–6 disk extrusion (black arrowhead) that displaces the dura (white arrowhead) posteriorly. A1 and A2, Sagittal (A1) and axial (A2) T2-weighted MR images from a patient with SS show a cervicothoracic epidural fluid-filled collection (white arrows) and a T5–6 disk extrusion (black arrowhead) that displaces the dura (white arrowhead) posteriorly. B1 and B2, Corresponding sagittal (reformatted) (B1) and axial (B2) postmyelography CT images demonstrate opacification of the ventral epidural fluid by intrathecal contrast to the same degree as the CSF, thus confirming an active leak. Note partial calcification of the disk (black arrowhead) and the presence of a subarachnoid clot (black arrow). C, Lateral view of the thoracic spine acquired during digital substraction myelography with the patient in the prone position. Note cephalad extension of the contrast in the thecal sac (black arrowhead), focal extravasation of the contrast through a ventral dural tear at T5–6 (white arrow) into the epidural collection (black arrow), and onward cephalad extension in the epidural fluid collection. The asterisk indicates increased attenuation of the contrast because of the smaller volume of the epidural space compared with the subarachnoid space. In this patient, a ventral dural tear at T5–6 was surgically repaired, and a thoracic spine MR imaging performed 3 months later showed resolution of the ventral epidural fluid collection.36 Adapted with permission from J.M. Hoxworth.36 N. Kumar AJNR Am J Neuroradiol 2010;31:5-14 ©2010 by American Society of Neuroradiology